Minnesota State health officials have identified green whole head cabbage as the likely source of an E. coli O111 outbreak that sickened 15 people in Minnesota in July. The cabbage was likely contaminated at some point prior to distribution to restaurants.
Routine monitoring by the Minnesota Department of Health (MDH) identified the 15 cases of illness associated with Shiga toxin-producing E. coli O111. Bacterial isolates from all of the cases had the same DNA fingerprint. This genetic strain of E. coli O111 had not been seen in the United States previously.
MDH investigators were able to interview 14 of the cases: 13 of them ate at 9 different Applebee’s restaurants in Minnesota, and one ate at Yard House.
Many cases had reported eating the Oriental Chicken Salad at Applebee’s, leading Applebee’s to voluntarily and out of an abundance of caution pull the menu item and specific ingredients from the salad from their menu for a time. It was returned to the menu after Applebee’s obtained different sources for the ingredients.
The common food item across all foods consumed by cases was green whole head cabbage.
Minnesota officials traced the cabbage to a common supplier outside of Minnesota and continue to work with the United States Food and Drug Administration (FDA) to investigate its source. The FDA examination of the potentially involved farms is still ongoing.
Single cases of illness that match the outbreak strain have occurred in three other states.
The illnesses occurred between June 25 and July 3. Four of the people who became ill were hospitalized and all have recovered. No new cases connected with this outbreak have been identified in Minnesota since July 10.
SW Wisc Dairy Goat Products Coop of Mt Sterling, Wisc is recalling Raw Milk Mild Cheddar Cheese Lot Code 103-114 because it may be contaminated with Shiga toxin producing Escherichia coli (STEC) O111:H8 bacteria. This is one of the 6 STEC strains that have been deemed to be of serious health concern as it can cause diarrheal illness, often with bloody stools, and may lead to more severe complications like Hemolytic Uremic Syndrome (HUS). HUS is most likely to occur in young children, the elderly and immunocompromised individuals and can lead to severe kidney damage and even death.
This product was distributed in the Midwest and Southwest regions of the US. This product was sent through distributorship in Wisconsin and Georgia. From these two states this product was then sent to retail stores in the Midwest and Southwest.
This product was packed as an 8oz cryovac retail size piece with the code 103-114 on a sticker attached to the side of the cheese. This product is all white in appearance and has a front and back separate label. The back label is a black and white nutrition and ingredient label and the front label is a yellow and blue colored label with the Mt Sterling Coop Creamery brand name. “No illnesses have been reported to date.”
The recall was initiated after a case of two five pound loafs in the original packaging was collected on 7-8—14 from an offsite warehouse. The product sample tested positive for Shiga toxin 1and was contaminated with E. coli O111:H8.
The Minnesota Department of Health has confirmed that at least 22 people on the Fond du Lac Band of Lake Superior Chippewa Reservation near Duluth have recently been sickened by foodborne illness linked to E. coli bacteria. The first illness was reported July 17.
The investigation is ongoing, but no specific cause has yet been found. The outbreak strain is believed to be E. coli O157, according to a department spokesman, which is not the one recently linked to Applebee’s restaurants in Minnesota.
The sickened reservation residents are being called and interviewed by a state epidemiologist, an environmental health supervisor and University of Minnesota graduate epidemiology students, the spokesman said.
Recent events on the reservation, including powwows, picnics, weddings, potlucks and outdoors meetings, have likely contributed to opportunities for foodborne illness. Residents were encouraged to throw away any leftover foods from these events.
Those experiencing symptoms of foodborne illness are advised to contact a health care provider or the local emergency room. More information and specific symptoms related to E. coli infection is available here.
The Minnesota Department of Health has provided the following contact numbers: toll free is 1-877-FOOD ILL (1-877-366-3455) or 1-651-201-5277 for individuals who have questions or would like to learn more about E. coli or any other foodborne illness. They advise callers to leave a message and someone will call back promptly.
The CDC reported on December 11, 2013, a total of 33 persons infected with the outbreak strain of E. coli O157:H7 were reported from four states. The number of ill persons identified in each state was as follows: Arizona (1), California (28), Texas (1), and Washington (3). 32% of ill persons were hospitalized. Two ill persons developed hemolytic uremic syndrome (HUS), and no deaths were reported.
Epidemiologic and traceback investigations conducted by local, state, and federal officials indicated that consumption of two ready-to-eat salads, Field Fresh Chopped Salad with Grilled Chicken and Mexicali Salad with Chili Lime Chicken, produced by Glass Onion Catering and sold at Trader Joe’s grocery store locations, was the likely source of this outbreak of E. coli O157:H7 infections.
On June 17, 2014, the California Department of Public Health Report that concluded that:
An outbreak of E. coli O157:H7 infections occurred in October and November of 2013, affecting 33 individuals in four western states. The outbreak disproportionately affected California residents, accounting for 85 percent of all case-patients. Two varieties of prepackaged RTE salads produced by “Company A” (Atherstone Foods – Glass Onion Catering) and sold by “GCA” (Trader Joe’s) were implicated as the source of infection. This is supported by the statistically significant association of case-patients with consumption of one of the two implicated “GCA” salad varieties and by the regional distribution of reported cases matching the regional distribution of these two salads. No other food items or exposures were associated with illness. While these salads were strongly associated with the outbreak, the exact source of the contamination remains undetermined.
Today the Food and Drug Branch – Emergency Response Unit – of the California Department of Public Health produced the Environmental Investigation of an E. coli O157:H7 Outbreak in October 2013 Associated with Pre-packaged Salads. The report 28 pages long with several hundred pages of attachments, traces the consumption of the salads to the possible source of the E. coli O157:H7 contamination.
This report not only implicates the two varieties of prepackaged salads noted above, but also two others – one produced by Atherstone Foods – Glass Onion Catering – and another produced by an unnamed manufacturer in Oakland – both for sale at Walgreens.
The investigators concluded that the one common item between the two manufacturers and the four salads was romaine lettuce from a single filed in Modesto, California grown by Ratto Bros. Five of 44 environmental samples collected in areas around the implicated farm tested positive for E. coli O157:H7, however, the “positive samples were not a genetic match to the outbreak strain” – not a match to the ill people.
Applebee’s restaurant officials have removed the chain’s popular Oriental Chicken Salad from the menu in Minnesota after at least seven diners fell ill with a rare strain of E. coli food poisoning, health officials said. The Applebee’s cases are among 13 reports of E. coli O111 infections in the state all tied to the same genetic strain of the bug — one that has not previously been seen in the U.S. In addition, two more cases have been reported in two other unidentified states, according to the Centers for Disease Control and Prevention. The six remaining cases in Minnesota appear to have no connection with Applebee’s, health officials said. Four of those sickened were hospitalized. Restaurant officials are cooperating fully with officials and pulled the salad and other ingredients included from the menu as a precaution. E. coli O111 is in the same family as the E. coli O157 typically tied to ground beef outbreaks. The infections are particularly dangerous to children and the elderly and can cause life-threatening complications. Anyone who visited a Minneapolis Applebee’s after June 20 and shows signs of diarrheal illness should contact a doctor.
The Minnesota Department of Health (MDH) is investigating 13 cases of foodborne illness associated with a type of E. colibacteria known as E. coli O111. This form of E. coli is in the same family as the more well-known E. coli O157:H7. All of the illnesses were caused by the same genetic strain of E. coli O111, and the ill people do not all share any obvious commonalities; these facts indicate the illnesses resulted from a widely distributed food item.
While seven of the people with E. coli O111 infections reported eating at Applebee’s restaurants in Minnesota between June 24 and 27, there are multiple cases with no apparent connection to the restaurant. Applebee’s is cooperating fully with the investigation, and as a precaution volunteered to remove the Oriental Chicken salad from menus at all its Minnesota restaurants while the investigation continues. The restaurant is also removing specific ingredients of its Oriental Chicken salad from other items on its menu out of an abundance of caution. Health officials are still working with Applebee’s, the Minnesota Department of Agriculture, and other regulatory partners to determine the cause of the outbreak.
Symptoms of illness caused by E. coli O111 typically include stomach cramps and diarrhea, often with bloody stools, but only a low-grade or no fever. People usually become ill two to five days after exposure, but this time period can range from one to at least eight days. Most people recover in five to 10 days. Complications from infection are more common among those with weaker immune systems, including young children and the elderly. MDH investigators note that this genetic strain of E. coli O111 has not been seen in the United States previously.
Health officials say anyone who visited a Minnesota Applebee’s since June 20 and has symptoms of E. coli O111 infection (particularly bloody diarrhea) should contact their health care provider immediately and inform them of their possible involvement in this outbreak. MDH also asks that they contact the department’s foodborne illness hotline at 1-877-FOOD-ILL (1-877-366-3455) to report the potential connection.
Four of the 13 people who became ill were hospitalized, and all have recovered or are recovering. Diarrhea associated withE. coli O111 infection should NOT be treated with antibiotics, as this practice might promote further complications. More information on E. coli infection can be found at www.health.state.mn.us. MDH will share more information with the public as the investigation continues.
Published by the Public Health Protection Unit of NHS Greater Glasgow and Clyde, the report said that 19 of the cases ate beef burgers at the Big Grill at SSE Hydro between 17 and 19 January, 2013. The remaining three individuals, all female, were “household contacts of these primary cases.”
The report said that the investigation uncovered evidence “strongly suggesting the possibility of processing errors leading to undercooking as well as the potential for cross contamination in the preparation and serving of the beef burger products.
The report also found that in the preparation of the burgers the searing of the meat was uneven, with some appearing to be well-seared while others “were barely seared with pink raw meat visible on the surface of the burger.”
Inspectors observed inadequacy of temperature monitoring records and weaknesses in temperature monitoring of food to test how cooked items were by staff.
It was also discovered there was “an inappropriate cleaning and disinfection regime, and an absence of documented evidence of a hazard analysis” at the venue.
As of June 27, 2014, a total of 18 persons infected with the outbreak strain of Shiga toxin-producing Escherichia coli O121 (STEC O121) have been reported from five states.
The number of ill persons identified in each state is as follows: Idaho (3), Michigan (1), Montana (2), Utah (1), and Washington (11).
44% of ill persons have been hospitalized. No ill persons have developed hemolytic uremic syndrome (HUS), and no deaths have been reported.
Epidemiology and traceback investigations conducted by local, state, and federal officials indicated that contaminated raw clover sprouts produced by Evergreen Fresh Sprouts, LLC of Idaho are the likely source of this outbreak.
The FDA conducted an inspection of Evergreen Fresh Sprouts’ facility on May 22-23, 2014; May 27-30, 2014; and June 6, 2014. During the inspection, FDA investigators observed a number of unsanitary conditions, including condensate and irrigation water dripping from rusty valves; a rusty and corroded mung bean room watering system; tennis rackets that had scratches, chips, and frayed plastic” used to scoop mung bean sprouts; a pitchfork with corroded metal being used to transfer mung bean sprouts; and a squeegee with visible corroded metal and non-treated wood being used to agitate mung bean sprouts inside a soak vat.